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Neurology Flashcards

1
Q

What are 4 things that could prompt an attack of trigeminal neuralgia?

A
  1. light touch
  2. cold / cold wind
  3. eating
  4. vibrations
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2
Q

What is thought to be the cause of trigeminal neuralgia?

A

compression of trigeminal nerve by loop of artery or vein

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3
Q

What is the medical treatment of trigeminal neuralgia?

A

carbamazepine first line (also oxcarbazepine; lamotrigine and baclofen also used in specialist setting)

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4
Q

What is the surgical treatment option for trigeminal neuralgia?

A

decompression of trigeminal nerve or damaging it to avoid pain transmission

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5
Q

How should medical treatment of trigeminal neuralgia be withdrawn?

A

once in remission for one month, should be slowly withdrawn

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6
Q

What is the underlying pathophysiology of Lewy body dementia vs Parkinson’s disease dementia?

A
  • Lewy body dementia - lewy bodies in cortical neurons
  • PD dementia - lewy bodies in substantia nigra
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7
Q

What is key clinical difference in Parkinson’s disease dementia vs. Lewy body dementia?

A

in PD, extrapyramidal symptoms precede cognitive symptoms by at least one year; in LBD these happen within 1 year of each other (tremor later in LBD, axial rigidity early, symptoms bilateral)

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8
Q

What is the most common presentation of amyotrophic lateral sclerosis?

A
  • asymmetrical limb weakness
  • mixture UMN/LMN signs
  • wasting of hands/anterior tibialis
  • fasciculations
  • absence of sensory signs
    no cerebellar signs, doesn’t affect extraocular muscles
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9
Q

What will NCS and EMG show in ALS?

A

NCS: normal motor conduction - helps exclude neuropathy
EMG: reduced number of action potentials with increased amplitude

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10
Q

What is the general rule for the management of migraine (acute vs. prophylaxis)?

A
  • 5HT agonists for acute episode
  • 5HT antagonists for prophylaxis
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11
Q

What is the treatment for acute migraine in adults vs. children?

A

adults: triptan + paracetamol/NSAID
children: 12-17y consider nasal triptan (rather than oral)

if ineffective - consider non-oral metoclopramide or prochlorperazine +- non-oral NSAID +- triptan

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12
Q

When is migraine prophylaxis given?

A

if significant impact on QOL/ADLs e.g. >once a week or prolonged and severe

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13
Q

What are the 3 options for migraine prophylaxis?

A
  1. amitriptyline
  2. propranolol
  3. topiramate
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14
Q

What are 2 things NICE suggest if propranolol/ topiramate/ amitriptyline fail for migraine prophylaxis?

A
  • acupuncture
  • riboflavin 400mg / day
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15
Q

What are 2 treatment options outside of NICE guidelines for migraine that specialists may consider?

A
  • candesartan
  • monoclonal antibodies that target calcitonin gene related peptide (CGRP) receptor e.g. erenumab
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16
Q

What is the NICE guidance regarding IV dexamethasone in meningitis in adults?

A

consider it as adjunctive treatment particularly if pneumococcal meningitis suspected, preferably starting before or with first dose of antibiotic (no later than 12 hours after starting)

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17
Q

What are 4 contraindications to IV dexamethasone in the treatment of meningitis?

A
  1. septic shock
  2. meningococcal sepsis
  3. immunocompromised
  4. meningitis following surgery
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18
Q

What are 4 situations when lumbar puncture should be delayed in meningitis?

A
  1. severe sepsis / rapidly evolving rash
  2. severe resp / cardiac compromise
  3. significant bleeding risk
  4. signs of raised ICP: focal neurology, papilloedema, continuous / uncontrolled seizures, GCS 12 or less
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19
Q

What are 7 things to send CSF for after LP in meningitis?

A
  1. glucose
  2. protein
  3. MCS
  4. lactate
  5. meningococcal + pneumococcal PCR
  6. enteroviral, herpes simplex and VZV PCR
  7. consider TB meningitis investigations
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20
Q

Which groups should have amoxicillin as well as IV cefotaxime for meningitis?

A

< 3 months old OR >65 years old, confirmed caused by Listeria

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21
Q

What antibiotic should be used if a patient has an allergy to penicillin / cephalosporins + needs treatment for meningitis?

A

chloramphenicol

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22
Q

What prophylaxis is given to close contacts of bacterial meningitis?

A

ciprofloxacin first line (also rifampicin)

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23
Q

If meningitis is confirmed as meningococcal, what extra measure should be taken for prophylaxis for contacts?

A

meningococcal vaccination (booster doses if had it in infancy)

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24
Q

What are 3 steps for managing acute migraine?

A
  • simple analgesia +- antiemetic (aspirin/ibuprofen)
  • rectal analgesia + antiemetic
  • triptan
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25
Q

What are 2 first-line prophylactics for migraine?

A
  1. betablockers
  2. amitriptyline

(valproate and topiramate used by specialists in secondary care)

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26
Q

What criterion must cluster headaches meet to be diagnosed as a cluster headache?

A

> 5 attacks occuring, from 1 every other day to 8 per day with no other cause for the headache

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27
Q

What are 3 aspects of the acute maangement of cluster headache?

A
  1. expert advice
  2. SC sumatriptan
  3. hyperbaric oxygen
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28
Q

What are 2 aspects of cluster headache prophylaxis?

A
  1. prednisolone - high dose in short course
  2. verapamil
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29
Q

What are the nerve roots responsible for the knee jerk reflex?

A

L3/4

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30
Q

What are the nerve roots responsible for the ankle jerk reflex?

A

S1/2

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31
Q

What are the the nerve roots responsible for the biceps reflex?

A

C5/6

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32
Q

How is a decision on first line treatment in Parkinson’s disease made?

A
  • motor symptoms affecting QOL: levodopa
  • motor sx not affecting QOL: non-ergot derived levodopa, dopamine agonist (E.g. cabergoline), MAO-Bi
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33
Q

What is second line treatment for Parkinson’s disease if a patient does not respond to optimal levodopa treatment / develops dyskinesias?

A

Addition of:
* dopamine agonist
* MAO-Bi
* COMT inhibitor

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34
Q

What are 3 key side effects of anti-Parkinsons’s medication?

A
  • sedation
  • hallucinations
  • impulse control disorders
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35
Q

What are 2 effects of not taking / absorbing anti Parkinson’s medication?

A
  • acute akinesias
  • neuroleptic malignant syndrome
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36
Q

What medication can be used for excessive daytime sleepiness in PD?

A

Modafinil

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37
Q

What can be used for ortho static hypotension in PD?

A

Stop offending meds, midodrine

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38
Q

What can be used to treat drooling in PD?

A

Glycopyrronium bromide

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39
Q

What drug can be used for excessive drooling in PD?

A

Glycopyrronium bromide

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40
Q

What drug is nearly always combined with levodopa and why?

A

Decarboxylase inhibitor - reduces peripheral metabolism of levodopa to limit side effects

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41
Q

What are 5 common adverse effects of levodopa?

A
  1. Dry mouth
  2. Anorexia
  3. Palpitations
  4. Postural hypotension
  5. Psychosis
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42
Q

What are 3 types of dyskinesias seen at peak dopamine dose?

A
  1. Dystonia
  2. Chorea
  3. Athetosis
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43
Q

What are 4 examples of dopamine receptor agonists?

A
  1. Bromocriptine (ergot)
  2. Cabergoline (ergot)
  3. Ropinirole
  4. Apomorphine
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44
Q

What are 4 key side effects of dopamine agonists?

A
  1. Pulmonary / cardiac / retroperitoneal fibrosis
  2. Sedation
  3. Impulse control disorders
  4. Hallucinations
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45
Q

What is an example of a MAO-B inhibitor?

A

Selegiline

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46
Q

What is the mechanism of MAO-Bi for PD?

A

Inhibit breakdown of dopamine released by dopaminergic neurons

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47
Q

What are 5 side effects of amantadine?

A
  1. Dizziness
  2. Confusion
  3. Ataxia
  4. Slurred speech
  5. Livedo reticularis
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48
Q

What are 2 examples of COMT-inhibitors?

A
  1. Entacapone
  2. Tolcapone
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49
Q

What is the mechanism of COMT inhibitors?

A

COMT is an enzyme involved in the breakdown of dopamine, and hence inhibitors may be used as an adjunct to levodopa therapy

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50
Q

When are antimuscarinics used in Parkinson’s?

A

Drug induced Parkinsonism

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51
Q

What are 3 antimuscarinic drugs that can be used for drug-induced Parkinsonism?

A
  1. Procyclidine
  2. Benzotropine
  3. Trihexyphenidyl (benzhexol
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52
Q

How are seizures classified?

A
  • focal onset - retained awareness or impaired awareness
  • generalised onset - motor and non motor (absence)

in generalised - awareness always impaired

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53
Q

What is the definition of epilepsy?

A
  • 2 or more unprovoked seizures occuring >24 hours apart OR
  • 1 unprovoked seizure AND the probability of further seizures similar to general recurrence risk after 2 unproboked seizures (>60% over next 10y)
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54
Q

Is dementia a risk factor for seizures?

A

Yes - people with Alzheimer’s disease are up to 10x more likely to develop epilepsy

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55
Q

Where in the brain do focal impaired awareness seizures most commonly arise from?

A

temporal lobe

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56
Q

When is treatment with benzodiazepine indicated in a seizure?

A
  • tonic-clonc seizure lasting >5 minutes
  • > 3 seizures in an hour
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57
Q

What is first line benzo treatment for seizures in the community?

A

buccal midazolam

rectal diazepam if preferred, IV lorazepam if IV access established

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58
Q

What are 3 methods of contraception that don’t interact with enzyme-inducing anti-epileptic drugs?

A
  1. medroxyprogesterone acetate injections
  2. IUS
  3. IUD
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59
Q

What is the first line treatment for generalised tonic-clonic seizures in a) males b) females?

A
  • a) sodium valproate
  • b) lamotrigine or levetiracetam

lamotrigine second line for males

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60
Q

What are the first and second line AED for focal seizures?

A
  • first line: lamotrigine or levetiracetam
  • second line: carbamazepine, oxcarbazepine or zonisamide
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61
Q

What are first and second line AEDs for absence seizures (petit mal)?

A
  • First line: ethosuximide
  • Second line: sodium valproate (M), lamotrigine or levetiracetam (F)
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62
Q

Which AED may exacerbate absence seizures?

A

carbamazepine

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63
Q

What is first line in a) males and b) females for myoclonic seizures?

A
  • a) sodium valproate
  • b) levetiracetam
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64
Q

What is first line in a) males and b) females for myoclonic seizures

A
  • a) sodium valproate
  • b) lamotrigine
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65
Q

When can AED medication be withdrawn in someone with epilepsy?

A

if seizure-free for >2 years

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66
Q

What does ILAE consider as epilepsy having resolved?

A
  • if seizure-free for past 10 years
  • no AED treatment for at least past 5y
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67
Q

What 6 things that cause a predominantly motor loss-type peripheral neuropathy?

A
  1. Guillain-Barre syndrome
  2. porphyria
  3. lead poisoning
  4. hereditary sensorimotor neuropathies - e.g. Charcot-Marie Tooth
  5. Chronic inflammatory demyelinating polyneuropathy (CIDP)
  6. diphtheria
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68
Q

What are 6 things which cause a predominantly sensory loss-type periphera; neuropathy?

A
  1. diabetes
  2. uraemia
  3. leprosy
  4. alcoholism
  5. vitamin B12 deficiency
  6. amyloidosis
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69
Q

What can occur secondary to B6 (pyridoxine) overdose?

A

peripheral neuropathy (also used as treatment in isoniazid-induced neuropathy)

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70
Q

What are 5 drugs which are risk factors for IIH?

A
  1. COCP
  2. steroids
  3. tetracyclines
  4. retinoids (isotretinoin) / vit A
  5. lithium
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71
Q

What are 6 aspects of treatment in IIH?

A
  1. weight loss
  2. specialists may initiate meds like semaglitide and topiramate
  3. acetazolamide
  4. repeated LP
  5. optic nerve sheath decompression and fenestration
  6. LP or VP shunt
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72
Q

What is Lhermitte sign?

A

In MS flexion of the neck causes paraesthesia of limbs (due to disease near dorsal column nuclei of cervical cord)

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73
Q

What are 2 possible triggers for cluster headaches?

A
  1. alcohol
  2. nocturnal sleep pattern
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74
Q

Which antiplatelet therapy is used lifelong in stroke/TIA?

A

Clopidogrel

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75
Q

When should anticoagulation be started in AF leading to stroke vs TIA?

A
  • stroke: commence after 2 weeks (delay if very large infarction)
  • TIA: immediately once imaging has excluded haemorrhage
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76
Q

What is a lacunar infarct?

A

involve occlusion of single penetrating branch of a large cerebral artery and affect internal capsule, thalamus and basal ganglia

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77
Q

What are 5 types of presentation of a lacunar infarct?

A
  1. purely motor (commonest)
  2. purely sensory
  3. sensorimotor
  4. ataxic hemiparesis (ipsilateral weakness + limb ataxia out of proportion to motor deficit)
  5. dysarthria - clumsy hand syndrome

lack cortical findings - aphasia, agnosia, neglect, apraxia, hemianopia

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78
Q

How should decisions about thrombectomy take into account a patient’s clinical status?

A

Pre-stroke functional status should be <3 on modified Rankin scale and NIHSS score >5

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79
Q

How should decisions about thrombectomy take into account a patient’s clinical status?

A

Pre-stroke functional status on Modified Rankin score of <3 and NIHSS score >5

80
Q

Within what time frame should thrombectomy be offered for anterior circulation stroke?

A
  • as soon as possible and within 6 hours of onset (with IV thrombolysis if within 4.5h)
  • as soon as possible if last well between 6-24h ago (including wake up strokes AND demonstrated salvageable brain tissue on CT perfusion scan or MRI with diffusion weighting showing limited infarct core volume
81
Q

Within what time frame should thrombectomy be offered for PROXIMAL posterior circulation stroke?

A

Consider thrombectomy (+ thrombolysis if within 4.5h) ASAP if last well up to 24h previously and salvageable tissue on perfusion CT or diffusion-weighted MRI

MUST BE PROXIMAL (basilar or posterior cerebral artery)

82
Q

What are 3 key ways that Listeria infection may present?

A
  1. Gastroenteritis
  2. Bacteraemia - flu-like illness
  3. CNS infection - meningoencephalitis, ataxia, seizures
83
Q

What are 3 types of presentation of Listeria?

A
  1. Gastroenteritis
  2. Bacteraemia - flu like illness
  3. CNS infection - meningoencephalitis, ataxia, seizures
84
Q

How is Listeria spread?

A

Contaminated food - usually unpasteurised dairy products

85
Q

What are 4 risk factors for Listeria infection?

A
  1. Elderly
  2. Neonates
  3. Immunosuppression - especially steroids
  4. Pregnancy
86
Q

What are 2 key ivv bc estimations to diagnosis listeriosis?

A
  • blood cultures - tumbling motility on wet mount
  • LP for CSF sampling - pleocytosis, often lymphocytes, raised protein, reduced glucose
87
Q

What is the management of Listeria / listeria meningitis?

A
  • amoxicillin / ampicillin
  • IV amoxicillin / ampicillin + gentamicin
88
Q

What nerve roots supply the sciatic nerve?

A

L4-5, S1-3

89
Q

Which 2 nerves does the sciatic nerve divide into?

A
  1. tibial nerve
  2. common peroneal nerves
90
Q

Which muscles are supplied by the sciatic nerve? Give 2

A
  1. hamstring muscles
  2. adductor muscles
91
Q

What are 4 features of sciatic nerve lesions?

A
  1. paralysis of knee flexion
  2. paralysis of all movements below knee
  3. sensory loss belowknee
  4. ankle and plantar reflexes lost, knee jerk intact
92
Q

What are 3 causes of sciatic nerve lesions?

A
  1. fractured neck of femur
  2. posterior hip dislocation
  3. trauma
93
Q

How does CNS tuberculous disease develop?

A

haematogenous spread, 2 stages (Rich + McCordock):
* small tuberculous lesions (Rich’s foci) develop in CNS, during bacteraemia of primary infection or shortly afterwards; can be dormant for year
* later, rupture/growth produces development of CNS tuberculosis

94
Q

How can CNS TB present?

A

meningitis or intracranial tuberculomas

95
Q

```

~~~

What do investigations show in meningeal TB?

A
  • CSF examination
  • head CT or MRI can show oedema, hydrocephalus, basilar meningeal thickening, or tuberculomas
96
Q

What do investigations show in tuberculomas?

A
  • diagnosis based on CT/MRI
  • CSF usually normal
97
Q

What is the management of CNS TB?

A

RIPE for 2 months
RI for 10 months

rifampicin, isoniazid, pyrazinamide, ethambutol

98
Q

What is the mechanism of action of triptans?

A

specific 5-HT1B and 5-HT1D agonists

99
Q

At what point during a migraine should triptans be taken?

A

as soon as possible after the onset of headache, rather than at onset of aura

100
Q

What are 5 adverse effects of triptans?

A
  1. tingling
  2. heat
  3. tightness (e.g. throat and chest)
  4. heaviness
  5. pressure
101
Q

What is a key contraindication to triptans?

A

patients with a h/o or significant risk factors for, ischaemic heart disease or cerebrovascular disease

102
Q

What dermatome is supplied by C2 nerve root?

A

posterior half of the skull (cap)

103
Q

What is the distribution of dermatome C3?

A

high turtleneck shirt

104
Q

What is the dermatome distribution of C4?

A

low collar shirt

105
Q

What is the dermatome distribution of C5?

A

ventral axial line of upper limb

106
Q

What is the dermatome that supplies the thumb and first finger?

A

C6 (make 6 with L hand by touching the tip of thumb + index finger together)

107
Q

What dermatome supplies the middle finger and palm?

108
Q

What dermatome supplies the ring and little finger?

109
Q

Which dermatome supplies the inframammary fold?

A

T5 (T4 = nipples)

110
Q

What dermatome supplies the xiphoid process?

111
Q

Which dermatome supplies the belly button?

112
Q

Which dermatome supplies the inguinal ligament?

113
Q

Which dermatome supplies the knee caps?

114
Q

Which dermatome supplies the big toe and dorsum of the foot?

A

L5 (L5 = largest of the 5 toes)

115
Q

Where does S1 dermatome supply?

A

S1 = the smallest one = lateral foot and small toe

116
Q

Which dermatomes supply the genitalia?

117
Q

How long do menopausal symptoms typically last for?

118
Q

What are the lifestyle modifications to help manage different symptoms of the menopause?

A
  • hot flushes: regular exercise, weight loss and reduce stress
  • sleep disturbance: avoid late evening exercise, good sleep hygiene
  • mood: sleep, regular exercise + relaxation
  • cognitive sx: regular exercise and good sleep hygiene
119
Q

What are 4 contraindications to HRT?

A
  1. current or past breast cancer
  2. oestrogen-sensitive cancer
  3. undiagnosed vaginal bleeding
  4. untreated endometrial hyperplasia
120
Q

What are 5 key risks of HRT?

A
  1. VTE (if oral; no increased risk if transdermal)
  2. stroke
  3. coronary heart disease
  4. breast cancer
  5. ovarian cancer
121
Q

What is the preferred antibiotic prophylaxis of contacts with meningitis?

A

ciprofloxacin (now preferred over rifampicin)

122
Q

When do NICE advice against giving corticosteroids in children?

A

children <3 months

123
Q

What are 3 situations when NICE advise consider dexamethsone in meningitis?

A
  1. frankly purulent CSF
  2. CSF WCC>1000
  3. raised CSF WCC with protein concentration >1g/L
  4. bacteria on gram stain
124
Q

What is the guidance for driving following first unprovoked/isolated seizure?

A

6 months off

125
Q

What is the guidance for driving for patients with established epilepsy/multiple unprovoked seizures?

A

may qualify to drive if seizure free for 12 months

126
Q

What is the guidance for driving after withdrawal of epilepsy medication?

A

should not drive whilst being withdawn and for 6 months afterwards

127
Q

What is the guidance for driving after syncope?

A
  • simple faint - no restriction
  • single episode, explained and treated: 4 weeks off
  • single episode, unexplained: 6 months off
  • 2 or more episodes: 12 months off
128
Q

What is the guidance for driving after stroke or TIA?

A

1 month off driving, may not need to inform DVLA if no residual neurological deficit

129
Q

What i the guidance for driving after multiple TIAs over short period of time?

A

3 months off and inform DVLA

130
Q

What is the guidance for driving with chronic neurological disorders e.g. multiple sclerosis, motor neuron disease?

A

inform DVLA, complete PK1 form

131
Q

What are 3 things that are different about paediatric migraine from adults?

A
  1. attacks may be shorter-lasting
  2. headache more commonly bialteral
  3. GI disturbance more prominent
132
Q

What are the patterns of radial nerve damage?

A
  • wrist drop
  • sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals
  • if axillary damage - paralysis of triceps as well
133
Q

What are 4 features associated with an essential tremor?

A
  1. postural tremor - worse when arms outstretched
  2. improved by alcohol and rest
  3. titubation
  4. strong family history (often)
134
Q

What is meant by the ulnar paradox in ulnar nerve lesions?

A

clawing more severe in distal ulnar nerve lesions

135
Q

What features will be seen in ulnar nerve damage at the elbow?

A
  • claw hand (less severe than more distal lesion - ulnar paradox)
  • wasting + paralysis of intrinsic hand muscles + hypothenar muscles
  • sensory loss medial 1.5 fingers (palmar and dorsal aspects)
  • radial deviation of wrist
136
Q

What features will be seen in ulnar nerve damage at the wrist?

A
  • claw hand (less severe than more distal lesion - ulnar paradox)
  • wasting + paralysis of intrinsic hand muscles + hypothenar muscles
  • sensory loss medial 1.5 fingers (palmar and dorsal aspects)
137
Q

What is first-line management of migraine in children < 12 / 12-17 / > 18?

A
  • < 12: oral ibuprofen
  • 12 - 17: sumatriptan nasal spray
  • > 18 - oral sumatriptan
138
Q

What is the most common cause of primary headache in children?

A

migraine without aura

139
Q

What are 7 red flag symptoms and signs suggesting a serious underlying cause of trigeminal neuralgia?

A
  1. sensory changes
  2. deafness or other ear problems
  3. history of skin or oral lesions that could spread perineurally
  4. pain only in ophthalmic division
  5. optic neuritis
  6. FH of MS
  7. age < 40 years
140
Q

Which muscle is weak in carpal tunnel syndrome and how does this present on exam?

A

abductor pollicis brevis - weakness of thumb abduction

141
Q

What are 5 causes of carpal tunnel syndrome?

A
  1. idiopathic
  2. pregnancy
  3. oedema e.g. heart failure
  4. lunate fracture
  5. RA
142
Q

What will electrophysiology show in carpal tunnel syndrome?

A

prolongation of action potential (motor and sensory)

143
Q

What are the treatment options for carpal tunnel syndrome?

A
  • mild-moderate: 6 week trial of conservative management - steroid inj, wrist splints at night
  • severe / persistent: surgical decompression (flexor retinaculum division)
144
Q

What is the underlying pathology in Guillain-Barre syndrome?

A
  • immune-mediated demyelination fo peripheral nervous system - progressive, symmetrical weakness of limbs
  • often ascending pattern
  • diminished reflexes
  • normal sensation
145
Q

What is the pathophysiology of GBS?

A
  • cross-reaction of antibodies with gangliosides in the PNS
  • correlation between anti-ganglioside antibody (e.g. anti-GM1) + clinical features
146
Q

How many patients with GBS have anti-GM1 antibodies?

147
Q

What is Miller Fisher syndrome?

A

variant of GBS with ophthalmoplegia, areflexia and ataxia

148
Q

Which muscles are typically affected first in Miller Fisher syndrome?

A

eye muscles

149
Q

How does the presentation of Miller Fisher syndrome differ from GBS?

A

descending paralysis rather than ascending

150
Q

Which antibodies can be seen in Miller Fisher syndrome and what proportion are they seen in?

A
  • anti-GQ1b antibodies
  • 90% of cases
151
Q

What may precede neurological findings in GBS?

A

65% of patients experience back/leg pain in initial stages

152
Q

Why is papilloedema sometimes seen in GBS?

A

reduced CSF resorption

153
Q

What are 2 key investigations in GBS and what will they show?

A
  1. LP - high protein, normal WCC (aluminocytologic dissociatin)
  2. NCS - decreased nerve conduction velocity, prolonged distal motor latency, increased F wave latency
154
Q

What is the dose of IM benzylpenicilline for meningococcal sepsis in children < 1 year?

155
Q

What is the dose of IM benzylpenicilline for meningococcal sepsis in children 1 - 10 years?

156
Q

What is the dose of IM benzylpenicilline for meningococcal sepsis in children < 10 years?

157
Q

What medication + for what duration is given in stroke in someone intolerant to clopidogrel?

A

aspirin + dipyridamole lifelong

158
Q

What 4 things are spared in motor neuron disease?

A
  1. sensory signs
  2. extraocular muscles spared
  3. no cerebellar signs
  4. abdominal reflexes usually preserved
159
Q

Which extremity is affected more in anterior cerebral artery stroke?

160
Q

What is affected more in middle cerebral artery stroke, upper or lower extremity?

161
Q

What are 3 classical features of middle cerebral artery stroke?

A
  1. contralateral hemiparesis and sensory loss
  2. contralateral homonymous hemianopia
  3. aphasia
162
Q

What are 2 classical features of a posterior cerebral artery stroke?

A
  1. contralateral homonymous hemianopia with macular sparing
  2. visual agnosia
163
Q

What vessel is affected in Wallenberg syndrome?

A

posterior inferior cerebellar artery (aka lateral medullary syndrome)

PICA

164
Q

Which blood vessel is affected in Weber’s syndrome?

A

branches of the posterior cerebral artery that supply the midbrain

165
Q

What blood vessel is affected in lateral pontine syndrome?

A

anterior inferior cerebellar artery

AICA

166
Q

What are 4 classic features of Wallenberg syndrome?

A
  1. ipsilateral facial pain and temperature loss
  2. contralateral limb/torso pain and temperature loss
  3. ataxia
  4. nystagmus
167
Q

What are the classic features of lateral pontine syndrome?

A

similar to Wallenberg syndrome
ipsilateral facial paralysis and deafness

168
Q

Which artery is affected by stroke in locked in syndrome?

A

basilar artery

169
Q

What electrolyte abnormality can be caused by phenytoin?

A

hypocalcaemia

170
Q

What is the antiplatelet therapy (+ dose) after a stroke?

A
  • aspirin 300mg OD for 2 weeks
  • then clopidogrel 75mg lifelong
171
Q

What are the indications for disease modifying drugs in multiple sclerosis?

A
  • relapsing-remitting: 2 or more relapses in last 1 year and able to walk >100m unaided
  • secondary progressive: 2 or more relapses in last 2 years and able to walk >10m unaided
172
Q

What are 5 examples of disease modifying drugs used for MS?

A
  1. natalizumab
  2. ocrelizumab
  3. fingolimod
  4. beta-interferon
  5. glatiramer acetate
173
Q

What are 3 options for the treatment of fatigue in MS?

A
  • amantadine
  • CBT
  • mindfulness
174
Q

What are the 2 first line options for spasticity in MS?

A
  1. baclofen
  2. gabapentin
175
Q

In addition to the 2 first-line drugs to treat MS spasticity, what are 3 other options?

A
  1. diazepam
  2. dantrolene
  3. tizanidine

cannabis + botox under investigation

176
Q

What must be done before the treatment of bladder dysfunction in MS?

A

US to assess bladder emptying - whether significant residual volume or not

177
Q

What are the options to treat baldder dysfunction in MS?

A
  • significant residual volume on US: intermittent self-catheterisation
  • no significant residual volume: anticholinergics
178
Q

What is first-line to treat oscillopsia in MS?

A

gabapentin

179
Q

What is the inheritance pattern of tuberous sclerosis?

A

autosomal dominant

180
Q

What are 5 cutaneous features of tuberous sclerosis?

A
  • ash leaf spots over skin - fluorescence under UV light
  • Shagreen patches - thickened skin near spine
  • adenoma sebaceum (angiofibromas) - butterfly distribution over nose/cheeks
  • subungual fibromata
  • cafe-au-lait spots
181
Q

What are 3 neurological features of tuberous sclerosis?

A
  1. developmental delay
  2. epilepsy - infantile spasms or partial
  3. intellectual impairment
182
Q

What are 5 types of cyst / tumours that can occur in tuberous sclerosis?

A
  1. retinal hamartomas - dense white areas on retina (phakomata)
  2. rhabdomyomas of heart
  3. gliomatous changes in brain lesions
  4. polycystic kidneys, renal aniomyolipomata
  5. lymphangioleiomyomatosis - multiple lung cysts
183
Q

What is the management of acute confusion when antipsychotics are needed in patient with Parkinson’s?

A

quetiapine and clozapine (atypical antipsychotics)

184
Q

Which type of virus causes temporal lobe encephalitis?

A

herpes simplex 1

185
Q

What is the EEG pattern seen in HSV encephalitis?

A

lateralised periodic discharges at 2 Hz

186
Q

What is the classic EEG finding in absence seizures?

A

3 Hz spike and wave

187
Q

Which nerve is affected in meralgia paraesthetica?

A

lateral femoral cutaneous nerve (LFCN)

188
Q

Which spinal roots does the lateral femoral cutaneous nerve originate from?

189
Q

What are 7 risk factors for meralgia paraesthetica?

A
  1. obesity
  2. pregnancy
  3. tense ascites
  4. trauma
  5. iatrogenic - pelvic osteotomy, spinal surgeries, laparoscopic hernia repair, bariatric surgery
  6. gymanastics, football, bodybuilding, strenuous exercise
  7. male > female
190
Q

What signs may be seen on examination in meralgia paraesthetica?

A

symptoms reproduced by deep palpation just below ASIS (pelvic compression) + hip extension
altered sensation over upper lateral aspect of thigh
no motor weakness

191
Q

What investigations are done for meralgia?

A
  • pelvic compressino test - highly sensitive
  • injectin of nerve with LA - abolishes pain
  • NCS
192
Q

What is the management of myasthenia gravis?

A
  • temporary treatment of muscle weakness: pyridostigmine (Ach esterase inhibitor)
  • generalised disease: immunomodulatory - steroids, azathioprine, ciclosporin, myocphenolate mofetil
  • monoclonal antibodies e.g. rituximab
  • PLEX / IVIG in exacerbations
193
Q

What GCS corresponds to different AVPU scores?

A
  • A = 15
  • V = 12
  • P = 8
  • U = 3
194
Q

What are 2 classic features of Weber’s syndrome?

A
  1. Ipsilateral CN III palsy
  2. Contralateral weakness of upper and lower extremity
195
Q

What is Saturday night palsy?

A

compression of the radial nerve against the humeral shaft (often due to sleeping on hard chair with hand draped over the back)

196
Q

What are 5 atypical aura symptoms for migraine, that may prompt further investigation / referral?

A
  1. motor weakness
  2. double vision
  3. visual symptoms affecting only 1 eye
  4. poor balance
  5. decreased level of consciousness
197
Q

What is the first line antibiotic recommended by the BNF for all cases of meningitis (apart from Listeria)?

A

IV cefotaxime (or ceftriaxone)

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